Needle Guidance Systems for Use with Ultrasound Devices

ABSTRACT

Ultrasound devices and guidance systems for ultrasound devices for subdermal devices (e.g., needles) used in conjunction with the ultrasound devices are described. The guidance systems can include features for easy release of a device from the system following targeting to a subdermal site. A guidance system can be ambidextrous such that a needle can be released by use of either the left or right hand and by use of either a thumb or a finger of an operator. Embodiments that include guidance tracks and slidable guidance cartridges that grasp the hub of a subdermal device are also described.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation application of U.S. patentapplication Ser. No. 14/593,404, having a filing date of Jan. 9, 2015,which claims filing benefit of United Stated Provisional PatentApplication Ser. No. 61/925,798, having a filing date of Jan. 10, 2014,entitled “Ergonomic Multi-Mode Ultrasound Device,” both of which areincorporated herein by reference.

BACKGROUND

Ultrasound devices are utilized for visualization in many differentmedical applications, including both diagnostic and proceduralapplications. Diagnostic applications include those in which internalstructures are merely visualized by use of an ultrasound device.Ultrasound guided procedural applications combine the visualizationcapability of the ultrasound device with invasive techniques such ascatheterization, centesis, and biopsy procedures that involve theplacement of a subdermal device, e.g., a needle, within a subject.

The proper placement of subdermal devices during procedural applicationspresents difficulties. For instance, proper insertion and placement of asubdermal device such as a needle depends on correct localization ofanatomical landmarks, proper positioning of the subject in relation tothe care provider, and awareness of both the depth of the subdermaltarget and the angle of the device insertion. Risks of unsuccessfulplacement of a subdermal device can range from minor complications, suchas patient anxiety and discomfort due to repetition of the procedurefollowing incorrect initial placement, to severe complications, such aspneumothorax, arterial or venous laceration, or delay of delivery oflife-saving fluids or medications in an emergency situation.

What are needed in the art are improved ultrasound devices and systemsas well as methods for using the devices and systems. For instance, whatare needed in the art are guidance systems that can be utilized toaccurately guide a subdermal device during a procedural application.

SUMMARY

According to one embodiment, disclosed is a system for use inconjunction with an ultrasound device. For instance, a system caninclude one or more guide rails that lay along a length of a track. Forinstance, the track can be on a length of a sterilizable shield for usein conjunction with an ultrasound device or another component of asystem for use with an ultrasound device. The system also includes aguide cartridge capable of being held in conjunction with the guide railsuch that the guide cartridge is in slidable conformation with thetrack, i.e., the guide cartridge is capable of sliding from a first endof the track to a second end of the track. The guide cartridge is alsoremovably attachable to a hub of a subdermal device and can hold thedevice as the tip of the device is targeted to an internal site of apatient.

Methods for using the systems are also described.

BRIEF DESCRIPTION OF THE FIGURES

A full and enabling disclosure of the present subject matter, includingthe best mode thereof to one of ordinary skill in the art, is set forthmore particularly in the remainder of the specification, includingreference to the accompanying figures in which:

FIG. 1 illustrates one embodiment of a multi-mode ultrasound device,including a first perspective view (FIG. 1A), a side view (FIG. 1B), afront view (FIG. 1C), and a second perspective view (FIG. 1D).

FIG. 2 illustrates a sterilizable shield that may be utilized inconjunction with an ultrasound device, including a perspective view(FIG. 2A), a side view (FIG. 2B), and a front view (FIG. 2C).

FIG. 3 illustrates another embodiment of a sterilizable shield,including an exploded view (FIG. 3A) and a combined view (FIG. 3B).

FIG. 4 illustrates an ambidextrous needle guide that may be utilized inconjunction with the sterilizable shield of FIG. 2, including a frontview (FIG. 4A), a top view (FIG. 4B), a perspective view (FIG. 4C), anda side view (FIG. 4D).

FIG. 5 illustrates the ambidextrous needle guide of FIG. 4 in an openconfiguration following opening from the first side of the guide,including a front view (FIG. 5A), a top view (FIG. 5B), a perspectiveview (FIG. 5C), and a side view (FIG. 5D).

FIG. 6 illustrates the ambidextrous needle guide of FIG. 4 in an openconfiguration following opening from the second side of the guide,including a front view (FIG. 6A), a top view (FIG. 6B), a perspectiveview (FIG. 6C), and a side view (FIG. 6D).

FIG. 7 illustrates a perspective exploded view of a system, includingthe device of FIG. 1, the sterilizable shield of FIG. 2, and theambidextrous needle guide of FIG. 4.

FIG. 8 illustrates another perspective exploded view of the system ofFIG. 7.

FIG. 9 illustrates a side view of the system of FIG. 7 followingassembly.

FIG. 10 illustrates a perspective view of the system of FIG. 7 followingassembly.

FIG. 11 illustrates another perspective view of the system of FIG. 7following assembly.

FIG. 12 illustrates one possible orientation of an ultrasound device asillustrated in FIG. 1 during a diagnostic application, including a frontview (FIG. 12A) and a side view (FIG. 12B).

FIG. 13 illustrates one possible orientation of a system during aprocedural application, including a front view (FIG. 13A) and a sideview (FIG. 13B).

FIG. 14 illustrates a guidance system for an ultrasound device,including a perspective view (FIG. 14A) of an ultrasound device seatedin the system and a sectional view (FIG. 14B) of the system along thesection A-A as shown in FIG. 14C.

FIG. 15 illustrates a sectional view of an interlocking guidance system.

FIG. 16 illustrates a sectional view of another interlocking guidancesystem.

FIG. 17 illustrates a sectional view of another interlocking guidancesystem.

FIG. 18 illustrates another embodiment of an ultrasound device,including a perspective view (FIG. 18A), a side view (FIG. 18B), and afront view (FIG. 18C).

FIG. 19 illustrates a sterilizable shield for use with the device ofFIG. 18, including a perspective view (FIG. 19A), a side view (FIG.19B), and a front view (FIG. 19C).

FIG. 20 illustrates an extension for use with the sterilizable shield ofFIG. 19, including a perspective view (FIG. 20A), a side view (FIG.20B), and a front view (FIG. 20C).

FIG. 21 illustrates a first perspective view (FIG. 21A), a side view(FIG. 21B), a front view (FIG. 21C), and a second perspective view (FIG.21D) of a system as described herein.

FIG. 22 illustrates track-based guidance system components, including aperspective view (FIG. 22A), a front view (FIG. 22B), a side view (FIG.22C), and a top view (FIG. 22D).

FIG. 23 illustrates two perspective exploded views (FIG. 23A, FIG. 23B)of a track-based guidance system in conjunction with a sterilizableshield and an ultrasound device.

FIG. 24 illustrates a track-based guidance system, including aperspective view (FIG. 24A), a side view (FIG. 24B), and a front view(FIG. 24C).

FIG. 25 illustrates one possible orientation of an ultrasound deviceduring a diagnostic application, including a front view (FIG. 25A) and aside view (FIG. 25B).

FIG. 26 illustrates one possible orientation of a track-based guidancesystem during a procedural application, including a front view (FIG.26A) and a side view (FIG. 26B).

FIG. 27 illustrates an interlocking track-based guidance systemincluding a perspective view (FIG. 27A) and a sectional view (FIG. 27B)along the section A-A as illustrated in FIG. 27C.

FIG. 28 illustrates a sectional view of another track-based guidancesystem.

FIG. 29 illustrates a sectional view of another track-based guidancesystem.

FIG. 30 illustrates a front view (FIG. 30A), a side view (FIG. 30B), anda perspective view (FIG. 30C) of a track-based guidance system includingguidance features. FIG. 30D illustrates a detailed view of the guidancefeatures and FIG. 30E illustrates a method for removal of a needle fromthe grasp of the guidance features.

FIG. 31 illustrates a front view (FIG. 31A), a side view (FIG. 31B), anda perspective view (FIG. 31C) of a track-based guidance system includingguidance features. FIG. 31D illustrates a detailed view of the guidancefeatures and FIG. 31E illustrates a method for removal of a needle fromthe grasp of the guidance features.

Repeat use of reference characters in the present specification anddrawings is intended to represent the same or analogous features ofelements of the disclosed subject matter. Other objects, features andaspects of the subject matter are disclosed in or are obvious from thefollowing detailed description.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Reference will now be made in detail to various embodiments of thedisclosed subject matter, one or more examples of which are set forthbelow. Each embodiment is provided by way of explanation of the subjectmatter, not limitation of the subject matter. In fact, it will beapparent to those skilled in the art that various modifications andvariations may be made in the present disclosure without departing fromthe scope or spirit of the subject matter. For instance, featuresillustrated or described as part of one embodiment, may be used inanother embodiment to yield a still further embodiment. Thus, it isintended that the present disclosure cover such modifications andvariations as come within the scope of the appended claims and theirequivalents.

In general, disclosed herein are guidance systems for ultrasound devicesthat can be utilized for both diagnostic and procedural applications. Inone embodiment, the ultrasound devices can have an ergonomic design andcan be held in a different orientation depending upon the type ofapplication that is being carried out. As such, the device can be heldin a comfortable position by the operator in both diagnostic andprocedural applications. More comfortable and ergonomic orientations canprovide improved stability to the device during use. Improved stabilitycan lead to improved visualization and, in the case of proceduralapplications, to less error in placement of subdermal devices. Theguidance systems for use with the ultrasound devices can provide foreasy use and accurate targeting, as well as simple separation of asubdermal device from the placement/ultrasound system following guidanceof the subdermal device to the target.

As utilized herein, the term “ultrasound device” generally refers to ahousing that incorporates an ultrasound transducer therein, as well asany hardware and software associated with the transducer and housing. Inone embodiment, the ultrasound device can be utilized in conjunctionwith a subdermal device, such as a needle, but does not necessarilyinclude the subdermal device itself. For instance, an ultrasound devicecan include a needle guide as an attachable or permanent component ofthe ultrasound device, and a needle can be utilized in conjunction withthe ultrasound device to access a subdermal site by guiding the needlethrough the needle guide of the ultrasound device.

As utilized herein, the term “subdermal device” generally refers to acomponent that can be guided to an internal site; for instance, fordelivery of a therapeutic (e.g., a compound or other treatment) to thelocation; for removal of material from the location; and so forth. Forexample, the term “subdermal device” can refer to a needle, a tube, abiopsy needle or blade, or any other item that can be guided to asubdermal location. In general, a subdermal device (also synonymous withthe term “subcutaneous device”) can be guided by and used in conjunctionwith an ultrasound device as described herein. In one embodiment, asubdermal device can define a ratio of the length of the device to thediameter (or a width) of the device greater than about 10. Moreover, asubdermal device can define any cross-sectional shape, e.g., round,square, oblong, triangular, rectangular, etc.

In one embodiment, an ultrasound device can include a detection systemthat can be utilized during procedural applications for detecting andvisualizing the subdermal device. A detection system can include adetector that is removably or permanently attached to the ultrasounddevice or a component of the system and that can recognize the locationand/or motion of a subdermal device, e.g. a needle, during theprocedure. During the procedure, the needle is guided such that theneedle tip approaches a targeted subdermal site that can be visualizedon a sonogram that is created from a plane of sound waves emitted by theultrasound transducer. Specifically, the needle is guided along a paththat has a known correlation with the plane of the sound waves emittedby the ultrasound transducer, e.g., coincident in the scanned plane,parallel to the scanned plane, or intersecting the scanned plane at apoint. The detector can register the location and/or motion of theneedle as it passes the detector on the ultrasound device and as theneedle tip proceeds into the subject. The detector can be incommunication with a processor that can utilize information receivedfrom the detector with regard to location of the needle and canaccurately identify the location of the needle tip in real time basedupon that information. A processor can also be in communication with amonitor and can create an image of a virtual needle on the monitor fromthe information received from the motion detector. The virtual needleimage can then be overlaid on the sonogram in real-time and portray themotion of the needle tip as it approaches the subdermal target. Thesystem can accurately correlate the location of the virtual needle tip,as determined by use of the detector, with the location of the actualneedle tip that is in the subject and provide real-time visualization ofthe entire procedure on the ultrasound. Such detection mechanisms andmethods have been described, for instance, in U.S. Pat. Nos. 8,496,592;8,425,425; 8,152,724; and 7,244,234, all of which are incorporatedherein by reference.

One embodiment of a multi-mode ergonomic ultrasound device 10 isillustrated in FIG. 1, which includes a first perspective view (FIG.1A), a side view (FIG. 1B), a front view (FIG. 1C), and a secondperspective view (FIG. 1D). The device 10 includes a handle 12 and abase 14. The base can include the skin contacting surface 16 that willbe either directly or indirectly held against the skin of a subjectduring use. For instance, when the device 10 is utilized in conjunctionwith a sterilizable shield, discussed further below, the sterilizableshield may be located between the skin contacting surface 16 and asubject's skin to provide a sterile barrier between the device 10 andthe subject. The skin contacting surface 16 will indirectly contact thesubject's skin in this case. The base 14 of the device can generallycontain the ultrasound transducer (not shown in FIG. 1).

Any type of ultrasound transducer as is generally known in the art canbe incorporated in transducer device 10 that can emit ultrasonic wavesand receive the reflection of the emitted ultrasonic waves. By way ofexample, a piezoelectric transducer formed of one or more piezoelectriccrystalline materials arranged in a one or two-dimensional array can beutilized. For instance, a one-dimensional array including a series ofelements in a line can be used to create a two-dimensional image.Alternatively, a single transmitter can be moved through space to createtwo-dimensional image. A two-dimensional array can include a matrix ofelements in a plane and can be used to create a three-dimensional image.A three-dimensional image can also be made by moving a two-dimensionalarray through space (rotationally or otherwise). Transducer materialsgenerally include ferroelectric piezoceramic crystalline materials suchas lead zirconate titanate (PZT), although other suitable materials areencompassed herein, such as CMUT/PMUT materials.

An ultrasound transducer can be formed of multiple elements. However,single transmitter/receiver devices are also encompassed by the presentdisclosure. The use of a multiple element ultrasound transducer can beadvantageous in certain embodiments, as the individual elements thatmake up the array can be individually controlled. Such control systemsare generally known in the art and thus will not be described in detail.

The ultrasound transducer can be located within the base 14 such that anultrasonic wave emitted from the device will pass through the skincontacting surface 16 and into a subject. The ultrasonic wave willgenerally pass through the skin contacting surface along a line 15 asshown in FIG. 1D. Line 15 has been extended on FIG. 1A and FIG. 1B forclarity.

The shape of all or a portion of an ultrasound device 10 may beparticularly designed to fit specific locations of the anatomy. Forexample, the skin contacting surface 16 may be shaped to be utilizedspecifically for infraclavicular approach to the subclavian vein;approach to the internal jugular vein; specific biopsy procedures,including, without limitation, breast biopsy, thyroid nodule biopsy,prostate biopsy, lymph node biopsy, and so forth; or some other specificuse. Variations in shape for any particular application can include, forexample, a specific geometry for the footprint of a skin contactingsurface 16.

The handle 12 of the device 10 includes a first side 13 and a secondside 11 that are opposite each other as shown. The handle also includesa proximal end 8 where the handle 12 meets the base 14 and an oppositedistal end 6. While the first side 13 is represented as the “front” ofthe device in the front view FIG. 1C, the device does not actually havea permanently defined “front” and “back” as the device can be held in adifferent orientation depending upon the application, as illustrated andexplained in further detail herein.

The handle 12 of the device 10 is set so as to be angled with the base14, which can provide an ergonomic design for both the procedural anddiagnostic applications. For instance, the angle that each side of thedevice need not be the same on the first and second sides 13, 11 of thedevice, which can improve the ergonomic design. To illustrate theseangles, FIG. 1B includes a first side line 17 and a second side line 19.

The first side line 17 contacts the two outermost points of the firstside 13 of the device (i.e., the line is tangent to the two outermostpoints of the first side 13) and extends at least from the distal end 6of the handle 12 past the proximal end 8 of the handle. The first sideline 17 has been extended on FIG. 1B for clarity. The angle ϕ₁ betweenthe first side line 17 and the line 15 along the skin contacting surface16 can be about 135° or less; for instance, from about 30° to about 90°,or from about 45° to about 85°. Note that this angle is as measuredthrough the device from the skin contacting surface 16 of the device tothe first side 13 of the device, i.e., the angle passes within thestructure of the device 10.

The second side line 19 contacts the two outmost points of the secondside 11 of the device and extends at least from the proximal end 8 ofthe handle 12 to the distal end 6 of the handle 12. The second side line19 has been extended on FIG. 1B for clarity. The angle ϕ₂ between thesecond side line 19 and the line 15 of the skin contacting surface canbe about 90° or greater; for instance, from about 90° to about 135°, orfrom about 95° to about 120°. Note that this angle is also measured fromthe skin contacting surface 16 of the device to the second side 11 ofthe device, i.e., as measured within the structure of the device.

In general, the two angles ϕ₁ and ϕ₂ will not add to 180°, and in oneembodiment, will add to less than 180°. In other words, the two sides 13and 11 will not be parallel to one another. This allows for each side tobe ergonomically designed for diagnostic and procedural applicationsindependently of one another, and also insures that the device can becomfortably and stably held for both types of applications.

An ultrasound system can include a detector that can register thelocation of a target that is associated with a subdermal device. Thisinformation can be electronically communicated to a processor andprocessed with input data (e.g., the length of the needle, etc.) anddisplayed as a real time image of a virtual needle in conjunction with asonogram, i.e., the two images, the image developed from the dataobtained by the detector, and the sonogram developed from the dataobtained from the ultrasound transducer, can be displayed on the samemonitor. Because the virtual needle location is correlated with theactual needle location, the location of the needle tip in relation tothe subdermal site and the striking of the subdermal site by the needletip can be seen in real time by an operator watching the virtual needleand the sonogram on the monitor during the procedure.

In general, any suitable detector can be utilized for detecting thetarget. For instance, a detector can utilize infrared (IR), ultrasound,optical, laser, magnetic, proximity, or other detection mechanisms. Inaddition, the location of a detector is not critical, save that it iscapable of detecting the target that is associated with the subdermaldevice during use. In addition, the target can be any suitable item. Itcan be all or a portion of the subdermal device itself, or it can bedirectly or indirectly attached to the subdermal device.

In one embodiment, the detector can be a permanent component of adevice. For instance, the ultrasound device 10 can include a series ofsensors (not shown) within the handle 12 that form a detector along alength of second side 11. The sensors can detect the presence and/ormotion of a target that can be attachable to a subdermal device. In oneembodiment of a magnetic-based detection system, sensors can be Halleffect sensors that are sensitive to a magnetic field, and the targetcan include one or more magnets. One exemplary embodiment of amagnetic-based detection system as may be incorporated in a device isdescribe in U.S. Pat. No. 8,425,425 to Haw, et al., previouslyincorporated herein by reference. Other magnetic-based sensor systemscan include, without limitation, anisotropic magnetoresistive sensors,tunneling magnetoresistive sensors, etc.

The detector is not necessarily included within the handle 12 of thedevice, and optionally can be either permanently or removably attachedto the handle 12, the base 14, or any other portion of a system. Forinstance, in one embodiment, a detector can be located on a sterilizableshield, discussed in more detail below.

Referring again to FIG. 1, the device 10 can include a cable 9 that canextend from the handle 12 of the device and carry power supply lines,information lines, etc. to provide communication from the device toother components of a system. The device 10 can also include a connector5 and a connector 3 that can be used to connect the device 10 to anothercomponent of the system (e.g., a sterilizable shield, a needle guide, acomponent of a guidance system, etc.); for instance, to properly alignthe ultrasound transducer with a subdermal device during use. Of course,any style of connector can be utilized, and a system can include one,two, three or more connectors to combine components of a system to oneanother.

Ultrasound device 10 also includes guide rails 43, 45 (described furtherherein) that can be components of a guidance system and used to guide asubdermal device during insertion and improve targeting of the subdermaldevice to an internal target.

FIG. 2 illustrates one embodiment of a sterilizable shield 20. In thisillustrated embodiment, the shield 20 has a shape to be utilized inconjunction with the device 10 of FIG. 1; for instance, in proceduralapplications requiring a sterile field. Of course, the shape of asterilizable shield can vary as needed to fit a particular ultrasounddevice. FIG. 2 includes a perspective view (FIG. 2A), a side view (FIG.2B), and a front view (FIG. 2C) of the sterilizable shield 20. Asterilizable shield 20 can be formed of sterilizable materials as aregenerally known in the art. In one embodiment, a sterilizable shield 20can be formed of single-use materials such as polymeric materials, andthe entire shield can be properly disposed of following a single use. Inanother embodiment, a sterilizable shield 20 can be utilized multipletimes, in which case it can be formed of a material that can be properlysterilized between uses. A sterilizable shield 20 can be formed of amoldable thermoplastic or thermoset polymeric material (or combinationsthereof) including, without limitation, polystyrenes, polyolefins (e.g.,polyethylene, polypropylene), polyurethanes, polysiloxanes,polymethylpentene (TPX), polyester, polyvinyl chloride, polycarbonate,and so forth. The shield can include materials of differentcharacteristics, such as materials of different stiffness, elasticity,strength, etc. For instance, a combination of stiff and pliablematerials can be utilized in forming a sterilizable shield.

Sterilizable shield 20 can include a shield base 22, a coupling 24, acasing 26, and a drape 21 (included in FIG. 2A). The shield base 22 canbe formed of an ultrasonic transmissive material. Shield base 22 can beof any suitable size and shape, and can be formed such that the base ofan ultrasound device may be seated firmly in shield base 22. Forinstance, the connector 5 of the ultrasound transducer 10 can align withand connect to a mated connector 25 and the connector 3 of theultrasound transducer 10 can align with and connect to a mated alignmentcoupling 38. In this particular embodiment, the alignment coupling 38 isa component of a needle guide base 37 that fits into a connection port23 on the shield base 22 as shown in FIG. 2. Generally, a small amountof an ultrasonic gel can be placed between the skin contacting surface16 of the ultrasound device 10 and the interior of the shield base 22during seating to prevent any air between the two and promotetransmission of ultrasonic waves.

Coupling 24 can connect the shield base 22 to the casing 26. The casingcan extend to cover at least a portion of the ultrasound device 10. Forinstance, in the illustrated embodiment, the casing 26 is formed of anon-pliable material that can extend upward from the base and enclose atleast a portion of an ultrasound device that can be seated in the shieldbase 22. As shown in FIG. 2A, the casing 26 can be attached to a drape21 that can cover an additional amount of the ultrasound device. Anycombination of components can be utilized in forming a sterilizableshield. For instance, in another embodiment, the sterilizable shield caninclude a pliable drape directly connected to the shield base. Thepliable drape can be formed of any suitable pliable material; forinstance, a pliable polymeric material such as a pliable sheet or filmthat can enclose the top of the ultrasound device with only the cable 9extending out of the sterilizable shield.

The utilization of a separate coupling 24 is not a requirement, and inother embodiments, the shield base 22 and the casing 26 (or drape 21)can be of either a unitary construction or, alternatively, directlyconnected to one another without the need for a separate coupling thatattaches the two together.

FIG. 3 illustrates another embodiment of a system that can include apliable, single-piece sterilizable shield 320 that can cover all or aportion of an ultrasound device 310. The sterilizable shield 320 can bepliable but still have a shape that is similar to that of the ultrasoundbase and/or can be somewhat elastic in nature in order that thesterilizable shield 320 can extend over the base 314 of the ultrasounddevice 310 so as to securely wrap at least the base 314 of the device310 without interfering with the workings of the system.

The system of FIG. 3 also includes a shell 350 that can include a shellbase 351 and an arm 352 that extends from the base 351. The shell base351 can fit over the base 314 of the ultrasound device and can help tohold the sterilizable shield 320 in place. In addition, the shell base351 can be open at the bottom such that upon assembly (FIG. 3B) thecontacting surface 316 of the ultrasound device 310 wrapped by thesterilizable shield 320 can be placed against the skin of a patient withmaterial of the shield 320 between the contacting surface 316 and thepatient's skin and none of the shell there between. The shell base 351can be directly or indirectly attached to the base 314 of the ultrasounddevice 310 by one or more connections with the sterilizable shield 320between the two or can be simply friction fit against the base 314 withthe sterilizable shield between the two. For instance, the system caninclude connection point(s) at the arm 352 of the shell 350 and/or atthe base 351 of the shell 350.

The arm 352 can extend from the base 351 such that upon assembly with anultrasound device 310, the arm 352 extends along a length of theultrasound device 310. The arm 351 can be a component of a needleguidance system that can serve to stabilize and target a subdermaldevice (e.g., a needle, as shown in FIG. 3) as it is directed to atarget. In one embodiment, the arm 352 can carry a needle guide (or oneor more components of a needle guide system) and can also carry adetector for detecting the motion of the needle as it passes along thearm 352 and into the patient. In another embodiment, a detector can belocated in the ultrasound device and the arm 352 can carry a needleguide (or one or more components of a needle guide system).

FIG. 4 illustrates one embodiment of a needle guide system 30. Theneedle guide system 30 is an ambidextrous system that can efficientlyhold and guide a needle (or other subdermal device) during targeting andcan also open on either side to release the needle from the needle guidesystem following targeting.

In one embodiment, an ambidextrous needle guide system can includecomponents for proper alignment with the transducer of an ultrasounddevice. For instance, referring to FIG. 2, the connection port 23 can beutilized for connection and alignment between a needle guide system 30and an ultrasound device via alignment coupling 38 of the system 30. Theneedle guide system 30 includes a base 37, and the base 37 includes analignment coupling 38. Upon attachment of the needle guide base 37 to asterilizable shield (or to a shell that is used in conjunction with asterilizable shield) via a suitable connection port (such as connectionport 23), the alignment coupling 38 can also properly align the guidancesystem 30 with the ultrasound transducer. For instance, when theultrasound transducer 10 is properly seated in the base 22 of thesterilizable shield 20, the alignment coupling 38 and connector 3 canmate and properly align the needle guide with the ultrasound transducer.

Of course, a device can include no alignment coupling or more than onealignment coupling, and these can be of the same or different shapes asone another. The utilization of one or more features that incorporatescomponents so as to connect a needle guidance system with a sterilizableshield and/or to properly align the needle guidance system with theultrasound transducer can insure proper alignment between the needleguide and the ultrasound transducer during a procedural application.

In any case, the needle guide base 37 can be permanently or removablyattached to a sterilizable shield such that when an ultrasound device isassembled with the sterilizable shield, a subdermal device that ispassed through the needle guidance system 30 will be aligned with theultrasonic beam emitted from the transducer of the device and subdermaldevice can be accurately targeted to an internal site.

The needle guidance system 30 can include separable hinges 33, 35 thatcan allow for separation of the needle guidance system (as well as theultrasound device and the sterilizable shield) from the needle followingplacement of the needle within the subject. Following proper placementof the needle at an internal site, the needle can be held within thesubject and the needle guidance system 30 can be removed from around theneedle so as to allow further procedural steps, such as threading of aguide wire through the needle and into the subject's blood vessel.

In the illustrated embodiment of FIG. 4, the needle guidance system canbe ambidextrous such that separation from a needle can be carried outquickly and easily by an operator using either the thumb or finger ofeither the left or right hand to control the device. FIGS. 4, 5, and 6illustrate one embodiment of an ambidextrous needle guidance system 30.

The system 30 includes a base 37. The base can be removably attachableto a sterilizable shield or some other component of an ultrasound devicesystem. Alternatively, the base can be formed as a permanent fixture ofa shield or some other component (e.g., a shell) of a system. In oneembodiment, the needle guide base 37 can be designed such that it can beattached and removed multiple times from another component such as asterilizable shield. This is not a requirement, however, and in otherembodiments the needle guide base 37 can be permanently disabled (e.g.,snapped or broken) following a single use.

FIG. 4 illustrates an ambidextrous needle guidance system 30 in a closedconfiguration including a front view (FIG. 4A), a top view (FIG. 4B), aperspective view (FIG. 4C), and a side view (FIG. 4D). The system 30includes a rotatable member 31 and a base 37 with a passage 36 definedbetween the two when the two are assembled together to form the closedassembly. The passage 36 can pass from one side to the other (e.g., fromthe top to the bottom) of the closed assembly and can generally be sizedso as to allow a particular gauge needle. The base 37 can include thealignment coupling 38 on one side of the base. The passage 36 is of asize to allow a subdermal device, such as a needle 39, to freely passthrough from the top of the assembly to the bottom, as shown in FIG. 4A.The rotatable member 31 includes a first tab 32 and a first separablehinge 33 on a first side of the needle guide 30 and a second tab 34 anda second separable hinge 35 on a second side of the device. During use,the rotatable member 31 can be opened on either side and separated fromthe base 37 on the open side so as to release a needle 39 held in thepassage 36. More specifically, the rotatable member 31 can be opened ateither the first side or the second side by use of either the first tab32 or the second tab 34, depending upon whether the operator is usingtheir finger, their thumb, their left hand, or their right hand.

FIG. 5 illustrates the needle guidance system 30 in an openconfiguration following opening of the passage 36 from the first side.FIG. 5 includes a front view (FIG. 5A), a top view (FIG. 5B), aperspective view (FIG. 5C), and a side view (FIG. 5D). As can be seen,when the first tab 32 is pushed to an open configuration, the firstseparable hinge 33 releases and the rotatable member 31 rotates aboutthe second hinge 35 on the second side. Thus, the needle guide 30 opensat the first side and remains closed at the second side.

FIG. 6 illustrates the needle guidance system 30 in an openconfiguration following opening of the passage 36 from the second side.FIG. 6 includes a front view (FIG. 6A), a top view (FIG. 6B), aperspective view (FIG. 6C), and a side view (FIG. 6D). As can be seen,when the second tab 34 is pushed to an open configuration, the secondseparable hinge 35 releases and the rotatable member 31 rotates aboutthe first hinge 33 on the first side. In this embodiment, the needleguide 30 opens at the second side and remains closed at the first side.

The hinges 33, 35 can be of a design and material (e.g., a polymericmaterial) such that they can be released relatively easily with aforward push by the thumb or forefinger of an operator. Thus, the needleguidance system 30 can be opened and the needle released by either theleft or right hand of an operator, as desired. This can improvestability of the device during needle release as an operator need notundergo any awkward contortions to release the needle, which can help toprevent dislodgement of the needle during the procedure.

FIG. 7 and FIG. 8 present two perspective exploded views of a system,including an ultrasound device 10, as illustrated in FIG. 1, asterilizable shield 20 as illustrated in FIG. 2, a needle guidancesystem 30 as illustrated in FIG. 4, and a needle 39, as an example of asubdermal device system incorporating the guidance system. As can beseen, the sterilizable shield can be assembled to include the shieldbase 22, the coupling 24, the casing 26, and the drape 21. Theultrasound device can be seated within the sterilizable shield and heldfirmly in place by use of the mating of connector 5 and the matedconnector member 25, as well as by the connector 3 and the alignmentcoupling 38 that mate via the connection port 23.

The base 37 of the needle guide can be attached to the base 22 of thesterilizable shield by use of the connection port 23, as shown, and therotatable member 31 of the needle guide can be attached to the base 37of the needle guide via the first hinge 33 and the second hinge 35.

In this particular embodiment, the needle 39 is associated with a target48, e.g., a magnetic target, which can be detected by a detector in theultrasound device, as discussed previously. For instance, the detectorcan include a series of Hall effect sensors located along the length ofthe handle 12 and on the second side 11 of the ultrasound device 10. Asshown in FIG. 8, in this embodiment, the second side 11 can includeridges 43, 45 that can help to guide the target 48 that is associatedwith the needle 39 as the needle 39 passes through the needle guide 30.Such guidance features can be a component of the ultrasound device asillustrated in FIG. 8 or, alternatively, can be a component of anothermember of the device. For instance, when utilizing a sterilizable shieldsystem as illustrated in FIG. 3, guidance features can be formed on theshell 352 and help to guide the needle as it passes through the guidancesystem.

In the embodiment of FIG. 8, the sensors can be arranged in one or morerows extending lengthwise along the second side 11 of the ultrasounddevice 10. As is known, the presence of a magnetic field can induce avoltage in a Hall effect sensor that is proportional to the size of themagnetic field. The voltage of each sensor can be electronically scannedand processed to determine the location of the target 48 relative to thesensing array (i.e., the detector). Processing can include grouping thesensors and providing their outputs to a series of multiplexers which,in turn, are connected to a processor including software for analyzingthe outputs and determining the location of the target 48 with regard tothe entire sensor array. As the distance from the target 48 to the tipof the needle 46 is constant and known, the processor can likewisecompute the location of the tip of the needle 46.

The processing of the sensor outputs can include determining whichsensor has the highest (or lowest, depending upon the magnetic fieldorientation) voltage output in a recognized grouping, corresponding tothe location of the target 48. In one embodiment, a processor cananalyze the output of the sensor having the highest voltage output and apredetermined number of sensor(s) to each side. The analog outputs ofthe sensors can be converted to digital output according to knownmethodology that can then be evaluated to determine the target location.More details concerning suitable magnet assemblies are described in U.S.Pat. No. 5,285,154 to Burreson, et al. and U.S. Pat. No. 5,351,004 toDaniels, et al., both of which are incorporated herein by reference.

In one embodiment, the subdermal device or the system that incorporatesthe subdermal device can include one or more tags that can carryinformation about the subdermal device and/or the subdermal deviceassembly, including, without limitation, the device type (e.g., needle,biopsy device, etc.), as well as the device geometry such as gauge,length, cross section, etc. The information from the tag(s) can beutilized to accurately determine a characteristic distance of thesubdermal device assembly; for instance, the distance from the center ofthe target 48 to the tip of the needle 46, which can then be used toaccurately correlate the location of the needle tip 46 as determined bythe detection system with the actual location of the needle tip in thesubdermal environment.

In one embodiment, the tag can include an identifying reference (e.g., asingle number identifying the subdermal device); for instance, in theform of an information chip. This reference can then be transmitted aprocessor that can be preprogrammed to recognize the code and access thepreprogrammed information needed for identifying the characteristics ofthe needle 39. Alternatively, the tag can be designed to directly carrythe desired information (e.g., geometric information).

The tag can be located at any convenient point on the subdermal deviceor an assembly including the subdermal device. For instance, the tag maybe located on or in a needle hub or attached to a needle hub, or it maybe a component of the target 48 (e.g., a magnet or magnets), or it maybe located on a needle guide, a shell, or a sterilizable shield. Forinstance, the subdermal device assembly can include a stylet, a syringe,a multi-component hub, a butterfly grip, and so forth, and the tag maybe located on or in or attached to any component of the assembly.

The tag can use any of a variety of technologies to provide informationto a processor of the ultrasound system. In one embodiment, the tag canbe a radio-frequency identification (RFID) tag. An RFID tag can be apassive type or an active type of RFID tag as is known in the art. Byway of example, RFID tags as described in U.S. Pat. No. 8,174,368 toUsami, U.S. Pat. No. 8,035,522 to Oroku, et al., U.S. Pat. No. 8,325,047to Marur, et al., and U.S. Pat. No. 7,876,228 to Kroll, et al., all ofwhich are incorporated herein by reference, can be utilized in the probedetection system.

While the general construction shown in FIG. 7 and FIG. 8 can be used,it should not be considered to be limiting. In this particularembodiment, the target 48 incorporates a permanent magnet, with amagnetic field having a flux density which has a maximum at or adjacentto the center of the magnet and which decreases as a function of thedistance moved away from the magnet. A single thin magnet can be used,or an array of magnets located side by side. The magnet or array ofmagnets can then be mounted in conjunction with a needle 39. Moreover,and as discussed previously, the system need not include a detector atall and, when included, can incorporate any suitable detection system.Additionally, when included, the detector can be located at any suitablelocation within the system. For instance, the detector may be located onthe sterilizable shield, rather than within or on the ultrasound device.

In those embodiments in which a magnetic detection mechanism isutilized, the magnetic material of the target 48 can be any suitablepermanent or electro-magnetic material that has a high enough energy tobe detectable over the distance between the target 48 and the sensors. Anon-limiting list of suitable materials can include, without limitation,samarium cobalt, neodymium, or iron boron.

FIG. 9, FIG. 10, and FIG. 11 present a side view, a first perspectiveview, and a second perspective view of the system of FIG. 7 and FIG. 8following assembly of the ultrasound device 10 with the sterilizableshield 20 (the drape 21 has been excluded from these views for clarity)and the needle guide 30. As shown in FIG. 9, the emitted ultrasonic wave18 can align with the needle path 52. The target 48 can pass along thesecond side 11 of the handle 12 and the detector within the handle 12can recognize the target 48 and determine the location of the target 48in relation to the detector.

Signals from the sensors can create a data stream which can be sent to aprocessor. A processing unit can be internal or external to anultrasound device 10. For example, data from sensors can be sent to astandard laptop or desk top computer processor or part of aself-contained ultrasound system as is known in the art. A processor canbe loaded with suitable recognition and analysis software and canreceive and analyze the stream of data from sensors. Input data for theprocessor, such as the length of the needle and so forth, can be enteredinto the processor by the user at the time of use or can bepreprogrammed into the system as default data, depending upon the natureof the data. Through analysis of the data stream received from thedetector, the processor can calculate the position of the needle tiprelative to the ultrasound transducer, relative to a sensor, relative tothe skin contacting surface of the device, or relative to any otherconvenient reference point. The processor can communicate this positioninformation digitally to a monitor, and the information can be displayedon the monitor such as in a numerical format or as a real time image ofa virtual needle.

A processing unit can also include standard imaging software as isgenerally known in the art to receive data from the ultrasoundtransducer that is a part of the ultrasound device 10. Morespecifically, the processor can receive data from the ultrasoundtransducer concerning the reflection of the emitted ultrasonic wave.This data can be processed according to known methodology to form asonogram on a monitor. The position information concerning the positionof the needle can be displayed on the monitor in conjunction with, e.g.,overlaid on, the sonogram that displays an image of the subdermal site,such as a blood vessel.

In such a manner, an ultrasound system can be utilized to show theapproach of a subdermal device toward a targeted site on a monitorthroughout the entire procedure. In addition, the system can be utilizedto ensure the device tip remains at the subdermal site during subsequentprocedures. For example, as long as the detector is interacting with thetarget, the virtual image of the needle can remain on the monitor. Thus,any motion of the needle tip in relation to the subdermal site can benoted by an observer.

As previously mentioned, the ergonomic devices can be held in differentorientations depending upon which mode of operation is being carriedout. As shown in FIG. 12, an ultrasound device 10 can be utilized in adiagnostic application, in which case the device need not necessarily becontained in a sterilizable shield. In this embodiment, the user cangrasp the device from the side 11, and the side 13 can be considered tobe the ‘front’ of the device during the diagnostic application. FIG. 12Aillustrates a front view of the orientation of the ultrasound device 10during a diagnostic application, and FIG. 12B illustrates a side view ofthe orientation of the ultrasound device during a diagnosticapplication. Of course, the orientation of the device during a procedurecan be altered for comfort or convenience, and the orientation of thedevice will not affect the ability of the device to carry out thedesired functions.

The orientation of the device 10 can differ during a proceduralapplication. For instance, in the embodiment as illustrated in FIG. 13,the device 10 can be combined with a sterilizable shield 20 and a needleguidance system 30. FIG. 13A illustrates a front view of the orientationof the ultrasound device 10 and system during a procedural application,and FIG. 13B illustrates a side view of the orientation of theultrasound device and system during a procedural application. The devicecan be oriented such that a user can grasp the device from the side 13,and the side 11 can be considered to be the ‘front’ of the device duringthe procedural application. In this orientation, the user can exert goodcontrol and skin contact during the application and can easily accessthe subdermal device and the rotatable member 31 of the needle guidewith either their forefinger or their thumb, depending upon whichapproach is more comfortable for the user. Moreover, though shown asbeing grasped in a left hand, the device would be equally comfortable,and the components of the device would be equally accessible, if theuser were to grasp the device with the right hand.

As previously mentioned, the guidance system can include guide rails onthe transducer housing, the sterilizable shield, the shell, or someother component of the system that can help to guide the subdermaldevice to the internal target. As illustrated in FIG. 8, the guide rails43, 45 can be relatively simple extensions from the adjacent surfacethat form a track that can constrain and help to guide the target 48.FIG. 14 illustrates a similar track-based guidance system in which theultrasound device 410 can be seated in a shell 450 that includes a base451 and an arm 452. The shell 450 can be utilized alone with theultrasound device 410 or, alternatively, in conjunction with asterilizable shield such as a pliable sock-type shield that covers aleast a portion of the ultrasound device 410. The arm 452 can includeguide rails 443, 445 that can contact the target 448 and constrainmotion of the target in the lateral direction and help to guide thesubdermal device 439 as it is targeted to an internal target. FIG. 14Aillustrates the system in a perspective view, and FIG. 14B illustrates asectional view along the section A-A as shown in FIG. 14C. As shown inFIG. 14B, the guide rails 443, 445 rest against the target 448 (or amember that is attached to or contains the target). Thus, as the needle439 is advanced, the guide rails 443, 445 will help to track the needle439 correctly.

The guide rails 443, 445 can extend along the length of the arm or onlypartly along the length, as desired. In addition to one or more guiderails, a guidance system can include a needle guide portion that cangrasp the needle as it advances and hold the needle and/or target at thedesired alignment. For example, the shell 450 and guide rails 443, 445can be used in conjunction with the ambidextrous system of FIG. 4 toprovide guidance for a subdermal device, though any other suitableneedle guide can alternatively be utilized.

A track-based guide rail system can be of any shape, size, and level ofinteraction with the subdermal device. For instance, FIG. 15 illustratesa sectional view of a guidance system in which the guide rails 453, 455of the shell arm 452 interlock with the target 458 to more tightly holdthe target 458 against the shell arm 452 and in proper relationship withthe ultrasound device 410 during use. Though illustrated as interlockingwith the target itself in FIG. 15, guide rails of such a system caninterlock with or otherwise constrain any suitable component of thesubdermal device or a member associated with the subdermal device. Forexample, a target (e.g., a magnet) for a detection system can be held byor formed within another member that in turn can be formed to interlockwith the guide rails.

A track-based guidance system can include one, two, three or more guiderails as desired to form a track for improved targeting of a subdermaldevice. For example, FIG. 16 and FIG. 17 illustrate two embodiments thatincorporate a single guide rail 463, 473 respectively. In FIG. 16, theguide rail 463 can interlock with the target 468 with dove-tail typegeometry so as to grasp the target 468 while still allowing the targetto move axially during insertion of the subdermal device. FIG. 17illustrates a T-shaped guide rail 473 that interlocks with the target478. Any shape or size of guide rail is encompassed herein. Forinstance, a dove-tail type of interlock can be a positive or negativedove-tail.

The ultrasound devices and shields that incorporate the disclosedguidance systems are not limited to any particular geometry. Forinstance, FIG. 18 illustrates another embodiment of an ergonomicultrasound device 110 including a perspective view (FIG. 18A), a sideview (FIG. 18B), and a front view (FIG. 18C). Device 110 includes a base114, a handle 112, and a skin contacting surface 116. An ultrasoundtransducer can be contained within the base 114 and can emit anultrasonic wave through the skin contacting surface 116 along a line115, similar to that of the device 10 illustrated in FIG. 1.

The handle 112 of the device 110 is set so as to be angled with the base114 and can provide an ergonomic design for both procedural anddiagnostic applications. In general, the angles of the handle to thebase will not be the same on the first and second sides 113, 111 of thedevice. To illustrate these angles, FIG. 18B includes a first side line117 and a second side line 119.

The first side line 117 contacts the two outermost points of the firstside 113 of the device and extends from at least the proximal end 108 ofthe handle 112 to the distal end 106 of the handle along the first side111. Note that in this particular embodiment, the first side 113 isessentially straight hence the first side line 117 runs generallycoincident with the first side 113. The first side line 117 has beenextended on FIG. 18B for clarity. The angle ϕ₃ between the first sideline 117 and the line 115 of the skin contacting surface can be greaterthan 90°; for instance, from about 92° to about 135°, or from about 95°to about 120°. Note that this angle is as measured from the skincontacting surface 116 of the device to the first side 111 of thedevice, i.e., as measured within the structure of the device 110.

The second side line 119 contacts the two outermost points of the secondside 111 of the device and extends from the proximal end 108 of thehandle 112 to the distal end 106 of the handle 112 along the second side113 of the device 110. The second side line 119 has been extended onFIG. 18B for clarity. The angle ϕ₄ between the second side line 119 andthe line 115 of the skin contacting surface can be about 135° or less;for instance, from about 30° to about 90°, or from about 45° to about85°. Note that this angle is also measured from the skin contactingsurface 116 of the device to the second side 113 of the device, i.e., asmeasured within the structure of the device.

In general, the two angles ϕ₃ and ϕ₄ will not add to 180°. In otherwords, the two sides 113 and 111 will not be parallel to one another.This allows for each side to be ergonomically designed for thediagnostic and procedural applications independently of one another, andalso insures that the device can be comfortably and stably held for bothapplications.

A sterilizable shield 120 as may be utilized in conjunction with thedevice 110 for procedural applications is illustrated in FIG. 19,including a perspective view FIG. 19A, a side view FIG. 19B, and a frontview FIG. 19C. Sterilizable shield 120 is a single, monolithic shieldwithin which the base 114 of device 110 can be seated. The sterilizableshield 120 can include a locking mechanism such as a tab 146 that canlock into a ridge 147 on the ultrasound device 110 to hold theultrasound device 110 firmly in place within the sterilizable shield120. Of course, a locking feature can be of any suitable design that canhold the components to one another as desired.

The sterilizable shield 120 can also include an extension 142 on theshield base 122. In this embodiment, the extension 142 is formed of aplurality of fins 143 that extend off of a side of the shield base 114.When present, the extension 142 may alternatively be formed of a single,monolithic piece. The extension 142 can help to stabilize the systemwhen the shield 120 is held against a subject's skin.

In one embodiment, a sterilizable shield 120 can include a removableextension 143, as illustrated in FIG. 20 in a perspective view (FIG.20A), a side view (FIG. 20B), and a front view (FIG. 20C). The removableextension can be attached to a convenient location on the sterilizableshield 120, for instance via a connector. The removable extension 143can have an angled side 141 that can be held against a subject duringuse and stabilize the system.

The sterilizable shield of FIG. 19 can be utilized in conjunction with aguidance system for a subdermal device. For instance, FIG. 21illustrates a first perspective view (FIG. 21A), a side view (FIG. 21B),a front view (FIG. 21C), and a second perspective view (FIG. 21D) of asystem 210. The system 210 includes a sterilizable shield 220. Thesystem 210 also includes an ambidextrous needle guidance system 230 aspreviously described. The ambidextrous needle guidance system 230includes a rotatable member 231 and a base 237 with a passage 236defined between the two for a needle 239. The passage 236 extends fromthe top of the assembly to the bottom of the assembly and allows forinsertion of the needle 239 therethrough. A system 230 can also includea track-based guidance system as discussed above (not illustrated inFIG. 21) that can optionally form an interlock between the target 248and the sterilizable shield 220 and can be used to enhance guidance ofthe subdermal device to a target.

A track-based guidance system can help to guide the subdermal deviceduring insertion by utilization of one or more guide rails that can forma track along which the subdermal device can slide during insertion ofthe device tip into a patient's body. As discussed above, the guiderails can contact a component of the subdermal device so as to constrainthe device within a track. The contact can be of any suitable level. Forinstance, the contact can be enough to constrain motion of the subdermaldevice in the lateral direction of the device and form a friction fit tohold the subdermal device and prevent free slippage in the longitudinaldirection. Alternatively, a higher level of constraint can be created,and the guide rail(s) can interlock with a component of subdermaldevice. For instance, the target of a detection system that is directlyor indirectly associated with the subdermal device can be the componentthat is constrained by the guide rails. In one embodiment, the target ofthe detection system can be attached to (e.g., held by) or formed withinanother component that is not directly detected by the sensor and thiscomponent can contact the guide rail(s).

FIG. 22 illustrates another embodiment of components of a track-basedguidance system. In this embodiment, the track-based guidance system caninclude a guide cartridge 130 that is illustrated in a perspective view(FIG. 22A), a front view (FIG. 22B), a side view (FIG. 22C) and a topview (FIG. 22D) in conjunction with a subdermal device including aneedle 139 and a needle hub 132. The guide cartridge 130 can be sized tohold a hub 132, and can in turn connect with a needle 139 as illustratedor, alternatively, with some other subdermal device. For instance, thehub 132 can hold a biopsy device, an extraction device, a deliveryvehicle, or any subdermal device. The track-based system can beuniversal with regard to subdermal device. For instance, the guidecartridge 130 can be sized to hold a standard needle hub 132, and anysuitably sized and type of subdermal device can be attached to the huband guided by use of the universal guide cartridge 130.

In those embodiments in which the system includes a detection system,the guide cartridge 130 and/or the hub 132 can carry the target for themotion detector and, optionally, can also carry an information tag aspreviously discussed. For instance, as illustrated in FIG. 22B, the hub132 can carry targets 488 in or on the hub such as permanent magnets themotion of which can be detected as the device is inserted into apatient. In another embodiment, the guide cartridge 130 can carry thetarget(s) for instance on a surface or within the body of the guidecartridge 130.

FIG. 23 includes FIG. 23A and FIG. 23B that illustrate two perspectiveexploded views of a system including the ultrasound device 110, thesterilizable shield 120, and guide cartridge 130 that contains a needlehub 132 connected to a needle 139, as well as a removable extension 143and extensions 142. The system also includes a guide track 140 that canseat the guide cartridge 130 such that the guide cartridge 130 isinterlocked with the guide track 140 and can slide along the guide track140 as the needle 139 is inserted into a patient.

FIG. 24 illustrates this system following assembly in a perspective view(FIG. 24A), a side view (FIG. 24B), and a front view (FIG. 24C). Theguide cartridge 130 is held within the guide track 140 is a slidablearrangement; for instance, by friction fit of the guide cartridge 130between the guide rails 182, 183 of the guide track. By sliding theguide cartridge 130 that holds the needle hub 132 down the guide track140, the needle can intersect the wave plane 118 of the ultrasonic wavethat is emitted from the ultrasound transducer 110 through the skincontacting surface 116 of the device 110. The ergonomic design of theultrasound device 110 and the extensions 142, 143 of the sterilizableshield 120 can work together to provide a system that can be comfortablyand stably held during a procedure.

As with other embodiments, the ergonomic device 110 and systemsincorporating the device can be held in different orientations dependingupon comfort of the use and which mode of operation is being carriedout. By way of example, as shown in FIG. 25, the device can be utilizedin a diagnostic application, in which case the device need not becontained in a sterilizable shield. In this embodiment, the user cangrasp the device from the side 111 and the side 113 can be considered tobe the ‘front’ of the device during the diagnostic application. FIG. 25Aillustrates a front view of the orientation of the ultrasound device 110during a diagnostic application, and FIG. 25B illustrates a side view ofthe orientation of the ultrasound device 110 during a diagnosticapplication.

The orientation of the device 110 can differ during a proceduralapplication. In this embodiment as illustrated in FIG. 26, the device110 can be combined with the sterilizable shield 120 and a guidancesystem including a guide cartridge 130 and a guide track 140. FIG. 26Aillustrates a front view of the orientation of the ultrasound device 110during a procedural application, and FIG. 26B illustrates a side view ofthe orientation of the ultrasound device during a proceduralapplication. The device can be oriented such that a user can grasp thedevice from the side 113 and the side 111 can be considered to be the‘front’ of the device during the procedural application. In thisorientation, the user can exert good control and skin contact during theapplication and can easily access the needle hub 132, needle 139 andguide cartridge 130 with either their forefinger or their thumb,depending upon which approach is more comfortable for the user.

The orientation of a track-based guidance system can vary, as can thenature of the interaction between the guide cartridge and the guidetrack. For instance, as illustrated in FIG. 27, the guide cartridge 530can be oriented with respect to a sterilizable shield 520 at 90° ascompared to the previous embodiment. FIG. 27 includes a perspective view(FIG. 27A) and a sectional view (FIG. 27B) along the section A-A asillustrated in FIG. 27C. As shown in the figures, the guide track 540can securely hold the guide cartridge 530 via a partial circular guiderail that interlocks with the guide cartridge. The guide cartridge 530can grasp the hub 532 that in turn is connected to the needle 539. Thus,by sliding the guide cartridge 130 down the guide track 540, the needle539 can be inserted through the skin and to/into a target at a subdermalsite.

FIG. 28 and FIG. 29 illustrate sectional views of alternative guidetracks 640, 740 respectively. As shown, the guide tracks 640, 740 cangrasp and, optionally, interlock with the guide cartridge 630, 730 so asto hold the guide cartridge 630, 730 as it slides down the guide track640, 740 and the tip of the subdermal device that is held within theguide cartridge is delivered to the targeted internal site. Aspreviously mentioned, the geometry of the guide rails is not limited,and alternative shapes are encompassed as would be understood by one ofskill in the art.

The guide rail(s) that can form a guide track for a track-based guidancesystem can extend all the way down the device that carries the track oronly part way, as discussed previously. In addition, in thoseembodiments in which there are multiple guide rails, the guide rails maybe of different lengths. In those embodiments in which the guide railsend at a distance from the skin entry point for the subdermal device, itmay be beneficial to include one or more additional guidance featuresfor the needle. For instance, and as illustrated in FIG. 30, in oneembodiment, a guidance system can include one or more guidance features801, 802 that extend from a component of a system (e.g., an ultrasounddevice, a sterilizable seal, a shell, etc.). FIG. 30 includes a frontview (FIG. 30A) a side view (FIG. 30B), and a perspective view (FIG.30C) of a track-based guidance system as described previously thatincorporates additional guidance features 801, 802. The guidancefeatures can be better seen in FIG. 30D in which a needle 839 is held inthe features 801, 802, and in FIG. 30E in which the needle 839 is in theprocess of being removed from the features 801, 802.

As a needle cartridge 830 slides down the guide track 840, the needlecan be fed between the guidance features 801, 802 for stabilization. Theguidance features can be formed of any suitable material such as amolded polymer. In one embodiment, the guidance features 801, 802 can besomewhat elastic in nature, which can facilitate removal of a subdermaldevice from the features. In one embodiment, the features can beretractable and can be pulled back away from the needle duringretraction, which can be used to free the needle from the features. Inthe embodiment of FIG. 30, the guidance system can include two guidancefeatures 801, 802 that can be spaced apart in the axial direction of theneedle, which can facilitate removal of the needle from the features. Inaddition, the guidance features 801, 802 can be located such that aneedle that is carried down the guidance track 840 can be fed betweenthe two features. Optionally, the needle 839 can contact one or both ofthe features as it passes. As seen in FIG. 30E, the needle can be simplyrotated out of the features 801, 802 for removal.

FIG. 31 includes a front view (FIG. 31A), a side view (FIG. 31B), and aperspective view (FIG. 31C) of a track-based guidance system, asdescribed previously, that incorporates a single guidance features 901.The guidance feature can be better seen in FIG. 31D in which a needle939 is held in the feature 901, and in FIG. 31E in which the needle 939is in the process of being removed from the feature 901.

As a needle cartridge 930 slides down the guide track 940, the needlecan be fed into the guidance feature 901 for stabilization. The guidancefeature can include a hinged cover 905 that when closed can define aneedle guide through the feature and upon opening, as shown in FIG. 31E,can release the needle 939.

Guidance features can be permanently or removably attached to the baseof a sterilizable shield or shell that is used with a sterilizable sealand beneath other components of a guidance system (such as beneath theguidance track as illustrated). Thus, the tip of a subdermal device canpass through the guidance features after it exits the guidance track foradditional stabilization prior to being inserted into the skin of apatient.

Following placement of a subdermal device at the internal target, theportion of the subdermal device that is still associated with theultrasound device can be conveniently removed from the attachedcomponents. For instance, upon placement of the tip of the subdermaldevice at the target, the guidance cartridge may still be constrainedwithin the guide rails of a guidance track. To separate the subdermaldevice, the guidance cartridge can be slid off of the guide rail(s) andlifted from the track for removal. In those embodiments that includeadditional guidance features at the base of the track, the subdermaldevice (e.g., the needle) can be removed from the guidance features byopening the feature, by rotation of the features and/or the subdermaldevice, by retraction of the features, etc. as necessary.

Presently disclosed ultrasound devices and methods may be utilized inmany different medical procedures. Exemplary applications for thedevices can include, without limitation:

-   -   Amniocentesis    -   Arthrocentesis    -   Biopsies (breast, kidney, liver, etc.)    -   Central Venous Catheterization    -   Cholecystic Drain Placement    -   Cardiac Catheterization (Central Arterial Access)    -   Diagnosis    -   Dialysis Catheter Placement    -   Epidural Catheter Placement    -   Imaging    -   Lumbar Puncture    -   Paracentesis    -   Pericardiocentesis    -   Peripherally Inserted Central Catheter (PICC) line placement    -   Regional Anesthesia—Nerve Block    -   Thoracentesis    -   Thyroid Nodule Biopsies

Some of these exemplary procedures have employed the use of ultrasounddevices in the past, and all of these procedures, as well as others notspecifically listed, could utilize disclosed ultrasound devices toimprove procedural safety, as well as patient safety and comfort, inaddition to provide more economical use of ultrasound devices.

It will be appreciated that the foregoing examples, given for purposesof illustration, are not to be construed as limiting the scope of thisinvention. Although only a few exemplary embodiments of this inventionhave been described in detail above, those skilled in the art willreadily appreciate that many modifications are possible in the exemplaryembodiments without materially departing from the novel teachings andadvantages of this invention. Accordingly, all such modifications areintended to be included within the scope of this invention which isdefined in the following claims and all equivalents thereto. Further, itis recognized that many embodiments may be conceived that do not achieveall of the advantages of some embodiments, yet the absence of aparticular advantage shall not be construed to necessarily mean thatsuch an embodiment is outside the scope of the present invention.

What is claimed is:
 1. A system for use in conjunction with anultrasound device comprising: a guide rail, the guide rail laying alonga length of a track; a guide cartridge capable of being held inconjunction with the guide rail such that the guide cartridge is inslidable conformation with the track along the length and the guidecartridge being capable of sliding from a first end of the track to asecond end of the track, the guide cartridge being removably attachableto a hub of a subdermal device.
 2. The system of claim 1, the guide railinterlocking with the guide cartridge.
 3. The system of claim 1, thesystem comprising a second guide rail.
 4. The system of claim 3, whereinthe guide rail and the second guide rail are the same or differentlengths.
 5. The system of claim 1, further comprising one or moreguidance features, the guidance features being in proximity of thesecond end of the track.
 6. The system of claim 1, further comprising asterilizable shield that is removably attachable to an ultrasoundtransducer.
 7. The system of claim 6, wherein the guide rail is locatedalong a length of the sterilizable shield.
 8. The system of claim 6,wherein the sterilizable shield comprises a pliable drape, the systemfurther comprising a shell that is removably attachable to an ultrasoundtransducer with the pliable drape between the shell and the ultrasoundtransducer, the guide rail being located along a length of the shell. 9.The system of claim 1, further comprising a target for a detectionsystem.
 10. The system of claim 9, wherein the target is associated withthe guide cartridge.
 11. The system of claim 9, wherein the target isassociated with the hub of the subdermal device.
 12. The system of claim9, wherein the target comprises one or more magnets.
 13. The system ofclaim 1, further comprising an identification tag.
 14. A method fortargeting a subdermal site comprising: attaching the hub of a subdermaldevice to the guide cartridge of the system of claim 1; sliding theguide cartridge along the length of the track from the first end of thetrack to the second end of the track as a tip of the subdermal deviceapproaches the subdermal site; and visualizing the subdermal site on amonitor by use of an ultrasound device that is removably attached to theguide cartridge of claim
 1. 15. The method of claim 14, furthercomprising removing the guide cartridge from the track by sliding theguide cartridge off of the guide rail.
 16. The method of claim 14,further comprising detecting the location of the tip of the subdermaldevice as the tip approaches the subdermal site.